A number of manually operated medical and surgical instruments are available for holding or grasping a suture needle. Generally, two varieties of surgical needles are commercially available: straight needles and curved needles. For many situations, straight needles are preferred since they can be more easily handled. In a restricted space, the use of a curved needle is preferred. However, curved needles are very difficult to properly manipulate manually and are invariably utilized in conjunction with needle holders specifically designed for use therewith. The most common needle holders include a configuration somewhat like needle-nose pliers with clamping means for locking the gripping jaws thereof in a fixed position.
A number of curved suture needle holders have been developed for use in invasive type surgery. Such holders commonly have a curved needle affixed to an elongated member for implementing a series of sutures. However, these holders are invariably too bulky to position in restricted surgical site areas and are near impossible to insert through a trocar sheath for endoscopic procedures due to physical size limitations.
With even more confined or limited access endoscopic procedures where the surgical instruments are typically inserted through a trocar sheath, the size of the suture needle is limited as well as the size of the needle holder which must be inserted through the trocar sheath to the surgical site. Endoscopic needle holders typically have a pair of opposing jaws positioned at the distal end of an elongated member which is inserted through the trocar sheath. One jaw is commonly held stationary while the opposing jaw is operated between an open and a closed position. To better grasp the suture needle, the opposing jaws commonly include a plurality of teeth for further grasping the needle.
One problem with these opposing jaw needle holders is the difficulty in maintaining a fixed position when the suture needle is grasped. This problem is further complicated with the use of a curved suture needle which is very common with endoscopic procedures. The curved needle has a tendency to change its position when grasped due to the curvature of the needle. As a result, the surgeon spends considerable time in making just a few sutures with the curved needle.
Another problem is that unless the curved needle is constantly maintained in perfect alignment along its own curvature during suturing, the perforated tissue offers resistance which increases the force necessary to complete the suture. As a result, there is increased tissue trauma with the formation of excessively large openings and possibly even tears in the tissue which may retard proper healing.
Another endoscopic needle driving instrument of the present inventor and disclosed in U.S. Pat. No. 5,015,250 includes an elongated cylindrical tube member with a channel formed near the distal end thereof for receiving a curved suture needle. The channel includes a plurality of surfaces for orienting the needle, and the curved needle is fixedly positioned in the channel by a wedge operable across the channel.
Although useful for its intended purpose, a disadvantage of this endoscopic needle driving instrument is that the suture needle is grasped several millimeters proximal to the distal end of the instrument. As a result, movement of the instrument is restricted in an extremely tight working space. In addition, this needle driving instrument receives, a needle in its channel through the top side of the instrument with an upward motion of the distal end of the instrument. As a result, the instrument is positioned underneath the needle for positioning the needle in the channel. Furthermore, the wedge is urged in a forward direction through the channel.